肝脏瞬时弹性成像对ALT低于2倍正常上限值的慢性乙型肝炎肝纤维化的诊断价值  

Value of fibroscan in diagnosis of heptic fibrosis in patients with chronic hepatitis B infection who had alanine ALT levels lower than 2 times the upper normal limit value

作　　者：孟玉丽[1] 张红旭[1] 余祖江[2] 梁红霞[2] 李志勤[2] 

机构地区：[1]漯河医学高等专科学校第一附属医院肝病科,462300 [2]郑州大学第一附属医院感染科

出　　处：《中国实用医刊》2016年第15期44-47,共4页Chinese Journal of Practical Medicine

摘　　要：目的：探讨肝脏瞬时弹性成像（ FS）在丙氨酸氨基转移酶（ ALT）﹤2倍正常上限值（ ULN）的慢性乙型肝炎（ CHB）患者肝纤维化中的应用价值。方法选择2014年3月至2015年3月诊治的ALT﹤2× ULN的CHB患者168例，运用FS进行肝脏硬度（ Stiffness）测量。所有患者均行肝穿刺活组织检查，以肝穿刺活组织检查病理结果为标准，Stiffness值与之对比，同时绘制受试者工作特征曲线，计算受试者工作特征曲线下面积，选定cut-off值。计量资料的组间比较采用Kruskal-Wallis H检验。结果随肝纤维化程度的提高，Stiffnes值逐渐增高，差异有统计学意义（ P﹤0.01或P﹤0.05），同一肝纤维化分期的CHB患者的Stiffnes随着肝组织炎症程度的加重而升高，在S0~S2肝纤维化分期中不同炎症组间比较差异有统计学意义（ P﹤0.05）。除S0期外，Stiffnes值与肝纤维化分期呈正相关（ r＝0.825，P﹤0.01）。FS检测肝硬化AUC为0.927，其中以15.1 kPa作为肝硬化诊断的界值，敏感度为88%，特异度为91%。结论 FS在ALT﹤2× ULN的CHB患者肝纤维化中具有较好的应用价值，尤其诊断肝硬化的准确性高，值得临床推广。Objective To evaluate the value of fibroscan in diagnosis of heptic fibrosis in pa-tients with chronic hepatitis B（ CHB）infection who had alanine aminotransferase（ ALT）levels lower than 2 times the upper limit of normal（ ULN）. Methods One hundred and sixty-eight patients with CHB in-fection who had alanine ALT levels lower than 2 × ULN from March 2014 to March 2015 ,were enrolled in this study. All patients underwent FS for liver stiffness measurement before liver biopsy. Statistical analy-sis was applied to compare liver stiness（ Kpa）with fibrosis stage（ determined by liver biopsy）. The re-ceiver operating characteristic（ ROC）curve of FS was constructed,and the area under the ROC curve （ AUC）was calculated to analyze the accuracy of live stiffness in predicting significant fibrosis and cirrho-sis. Comparison between groups was made by Kruskal-Wallis H test. The correlation between two varia-bles was analyzed by Spearman rank and Pearson correlation test. Results Liver stiffness gradually rose as the degree of hepatic fibrosis increased,there were significant differences（P﹤0. 01 or P﹤0. 05）ex-cept the comparison between S0 and S1（0. 237）. The liver stiffness with the same stage of liver fibrosis was found to increase with the progression of liver inflammation;Liver stiffness was positively correlated with the stage of hepatic fibrosis（ r=0. 825 ,P﹤0. 01 ）. The AUC of liver stiffness for detecting liver cir-rhosis was 0. 927;the cut-off value for diagnosing liver cirrhosis was 15. 1 kPa;the sensitivity was 88%, and the specificity was 91%. Conclusions FS is a promising noninvasive method for the assessment of hepatic fibrosis in patients with CHB infection who has alanine ALT levels lower than 2 × ULN;particu-larly,it has high accuracy in the diagnosis of liver cirrhosis,and the clinical application is highly recommend.

关 键 词：瞬时弹性成像 慢性乙型肝炎 丙氨酸氨基转移酶 

分 类 号：R512.62[医药卫生—内科学]